Bias towards drugs in medical research

Some readers will already be aware of my strong preference for natural treatments as the first choice over drugs. This study compares the benefits of exercise with those of drugs for secondary prevention of coronary disease, stroke rehabilitation, heart failure treatment, and diabetes prevention.

The particular natural treatment studied here - exercise - is, as most of us know, NOT a suitable treatment for ME/CFS.

However, this paragraph discusses the general bias towards drugs in research (which is likely to be reflected in biases in clinical practice and public perception):

Our findings reflect the bias against testing exercise interventions and highlight the changing landscape of medical research, which seems to increasingly favour drug interventions over strategies to modify lifestyle. The current body of medical literature largely constricts clinicians to drug options.48 This blind spot in available scientific evidence prevents prescribers and their patients from understanding the clinical circumstances where drugs might provide only modest improvement but exercise could yield more profound or sustainable gains in health. The lopsided nature of modern medical research may fail to detect the most effective treatment for a given condition if that treatment is not a prescription drug.

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Many of us here have chosen a natural route towards health improvement, many of those with tentative hopes of eventual cure, or at least complete remission.

As one such, I am heartened by the publication of this paper.

We will just have to keep a careful watch against its conclusions being inappropriately generalised. For example, some 'experts' might actually start suggesting exercise as a treatment for ME...

I think the reason for the bias is that doctors don't want to be liable. They can't count on patients to keep exercise regimens as much as they can that they will take their medication because taking pills is so much easier. And it's probably easier to prove that the patient didn't take them and so it's not doctors fault.

On the other hand, exercise is prescribed to us only by those doctors who think there's nothing wrong with us so they don't fear liability.

I think the reason for the bias is that doctors don't want to be liable. They can't count on patients to keep exercise regimens as much as they can that they will take their medication because taking pills is so much easier. And it's probably easier to prove that the patient didn't take them and so it's not doctors fault.

On the other hand, exercise is prescribed to us only by those doctors who think there's nothing wrong with us so they don't fear liability.

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If doctors think that people can be trusted to take their meds, perhaps they should read this:

A report by the Department of Health estimates that unused medicines cost the NHS around £300 million every year, with an estimated £110 million worth of medicine returned to pharmacies, £90 million worth of unused prescriptions being stored in homes and £50 million worth of medicines disposed of by Care Homes.

These startling figures don't even take into account the cost to patients' health if medicines are not being correctly taken. If medicine is left unused, this could lead to worsening symptoms and extra treatments that could have been avoided.

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The sum quoted would probably have to be multiplied many times to calculate the US amount, although it's possible that their different healthcare system would make it incomparable. I tried a quick search to get US figures, but all the first hits related to specific conditions or situations. I'm sure general figures must be available somewhere.

I believe some doctors in the UK are already prescribing exercise for appropriate conditions (as well as inappropriate ones - now what could they be...?) and are seeing some benefits both in health terms and in cost terms.

It's easier to do dot able blind rcts for drugs than behavioural interventions!

There are biases both way, and since reading more research, I've become more broadly sceptical of the value of all medical interventions. There aware lots of things that bias systems towards an intervention like exercise: cheap, shifts responsibility to patient, likely to lead to response bias, etc. Best to be cautious about it all IMO.

It's easier to do dot able blind rcts for drugs than behavioural interventions!

There are biases both way, and since reading more research, I've become more broadly sceptical of the value of all medical interventions. There aware lots of things that bias systems towards an intervention like exercise: cheap, shifts responsibility to patient, likely to lead to response bias, etc. Best to be cautious about it all IMO.

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Scepticism and caution are always a good idea in medicine, IMO.

I can see how it would be hard to measure compliance with exercise. Actimeters could help.

But supplements and herbal medicines can be tested in clinical trials as synthetic drugs are, and home use could be checked periodically with blood tests. To some extent dietary changes could be monitored through blood tests, perhaps. Trouble with diet, though, is that conventional medical advice is very poor.

But supplements and herbal medicines can be tested in clinical trials as synthetic drugs are, and home use could be checked periodically with blood tests. To some extent dietary changes could be monitored through blood tests, perhaps. Trouble with diet, though, is that conventional medical advice is very poor.

But who will want to fund such research?

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There has been bits and pieces of good research. Some things have been found helpful, some not.

I fear that a lot of the herb/supplement stuff is a bit ritualistic, and founded on an even worse evidence base than we see with other medicine. A lot of mainstream diet advice is based on a really poor evidence base, but the same can be said for alternative approaches. I'm wary of any claims of expertise in this area. It's probably best to avoid too much sweet stuff, and try to get some fruit and veg... other than that, I really wouldn't like to say.

Frankly I think it's partly consumer driven as well. People want a magic bullet that will be an easy fix. Exercise, diet changes. lifestyle changes....these take work and commitment and dedication that a lot of people just aren't willing to make.

My husband complains about his back, I show him exercises to do to help it and his comment is always, "I should have married a pharmacist".

Most drugs treat symptoms rather than disease, they might fix part of the picture, but not the whole picture. Drugs taken after the fact also don't fix any damage done already. Exercise alone won't necessarily 'fix' the problems either, but may be a catalyst to leading a healthier lifestyle in general. I wonder how other lifestyle factors were controlled for?

In comparing drugs to exercise (such as in the study above), it is important to also consider what happens when you combine the two, we should expect risk to drop even further.

Most drugs treat symptoms rather than disease, they might fix part of the picture, but not the whole picture. Drugs taken after the fact also don't fix any damage done already. Exercise along won't necessarily 'fix' the problems either, but may be a catalyst to leading a healthier lifestyle in general. I wonder how other lifestyle factors were controlled for?

In comparing drugs to exercise (such as in the study above), it is important to also consider what happens when you combine the two, we should expect risk to drop even further.

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I agree that many drugs only treat symptoms, but some do have a disease-modifying effect, and/or can fix existing damage.

Exercise can also modify/treat disease processes, e.g. it can improve cardiovascular health and strengthen muscles and joints.

Combining drugs and exercise is sometimes beneficial as long as the drugs don't have adverse effects, which many do.

It's a matter of seeing what is best for a specific condition and a specific person. The same treatments will not be suitable for other conditions and other people.

One example I can think is rheumatoid arthritis (which I thought was referred to in this thread by someone, but maybe it was another one) vs osteoarthritis. They are distinct diseases and need different treatments.